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Rethinking Well-Child Care, an article published in the July 2004 issue of
Pediatrics, presents an analysis of the nation's system of preventive
pediatric care and proposed revisions to address children's chronic health
problems and unmet behavioral and developmental needs. The analysis,
supported by the Commonwealth Fund, provides background information on
preventive pediatric care, including parent expectations, experience in
pediatric practice, and barriers to high-quality preventive care. The
author proposes changes to the periodicity schedule and office systems and
discusses the development of standards for preventive care quality and the
need for pediatricians to further enlist the community of child and family
advocates in caring for individual children and in formulating national
policies. A brief summary of the article is available from the
Commonwealth Fund Web site athttp://www.cmwf.org/programs/child/scho ... tl_757.pdf.
The article is available to subscribers of Pediatrics athttp://pediatrics.aappublications.org/c ... /1/210.pdf.

Translating Research into Practice: Speeding the Adoption of Innovative
Health Care Programs showcases eight key factors influencing the diffusion
and adoption of evidence-based innovations from research into practice.
The authors of the issue brief, published by the Commonwealth Fund,
conducted four case studies of four varied clinical programs that were
empirically proven to be effective and that were then adopted by many
health professionals. One of these programs, Healthy Steps for Young
Children, is a national initiative to foster the healthy growth and
development of children from birth to age three. The brief presents
background information, a description of the innovations and their
diffusion into wider practice, a conceptual framework and lessons learned
about diffusing innovations in the clinical setting, and a summary of the
authors' findings. The brief is intended for use by health professionals,
policymakers, and researchers in meeting the challenges of translating
evidence-based quality innovations into clinical practice. The brief is
available athttp://www.cmwf.org/programs/elders/bra ... ch_724.pdf.

"Because of the substantial burden of violence among adolescents in the
United States and the importance of this problem from public health and
societal perspectives, the determination of the effectiveness of secondary
prevention programs (e.g., therapeutic foster care) in reducing associated
forms of violence is critical," state the authors of a report published in
the July 2, 2004, issue of Morbidity and Mortality Weekly Report:
Recommendations and Reports. The report provides an overview of the
process used by the U.S. Preventive Services Task Force to select and
review evidence and summarizes the task force's recommendations pertaining
to the effectiveness of therapeutic foster care programs in preventing
violence.

A multidisciplinary review team conducted a systematic literature review
and identified five studies that reported the effects of therapeutic
foster care programs on violence by juveniles. The studies assessed two
similar but differing types of interventions, distinguished by the ages
and underlying problems of the target population. The first type of
intervention studied was therapeutic foster care for the reduction of
violence by children (ages 5-13) with severe emotional disturbance. The
second type was for the reduction of violence by chronically delinquent
adolescents (ages 12-18).

The authors found that

* Two studies involved programs (average duration = 18 months) in which
clusters of foster-parent families cooperated in the care of children
(ages 5-13) with severe emotional disturbance (referred to as cluster
therapeutic foster care). There was insufficient evidence to determine the
effectiveness of cluster therapeutic foster care in preventing violence
among children with severe emotional disturbance.

* Three studies involved programs (average duration = 6-7 months) in which
program personnel collaborated closely and daily with foster families
caring for adolescents (ages 12-18) with a history of chronic delinquency
(referred to as program-intensive therapeutic foster care).
Program-intensive therapeutic foster care is associated with a reduction
in violence among juveniles with a history of chronic delinquency.

"On the basis of sufficient evidence of effectiveness, the task force
recommends program-intensive therapeutic foster care for the prevention of
violence among adolescents with histories of chronic delinquency," state
the authors.

Readers: A full review of the evidence will be published in a supplement
to the American Journal of Preventive Medicine. The findings from
systematic reviews of eight types of firearm laws, early childhood home
visitation to prevent violence, and transfer of juveniles to the adult
judicial system have been completed previously. These are available athttp://www.thecommunityguide.org.

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4. ARTICLE EXPLORES THE RELATIVE EFFECTS OF INSURANCE COVERAGE AND
COMMUNITY HEALTH CENTER CAPACITY ON ACCESS TO CARE

"Insurance coverage expansions and safety-net expansions should not be
viewed as alternative solutions to the same problem but as complementary
approaches," state the authors of an article published in the July/August
2004 issue of Health Affairs. The article (1) describes variations in
insurance coverage and community health center (CHC) availability across
different U.S. population subgroups and communities and (2) examines the
relative effects of increased insurance coverage vs. CHC expansion on
access to care for people with low incomes.

Data were drawn from the 1998-99 Community Tracking Study (CTS) household
survey and the Uniform Data System (UDS). The CTS household survey
provided representative estimates of peoples' health insurance coverage,
access to care, use of services, and perceived quality. The UDS provided
detailed information on revenues, services, and users for federally
qualified health centers that receive federal grants (and other
"look-alike facilities").

Individual CHC sites in the UDS were linked to each person in the CTS
household survey by zip code. CHC capacity measures included (1) the
distances to every CHC within the CTS site for every person and (2) the
total grant revenue across all CHC facilities within 5 miles of people's
residences. To examine how differences in insurance coverage and CHC
capacity may affect access to care among people with low incomes,
researchers classified a subset of the CTS communities into four groups:
(1) relatively strong on both insurance coverage and CHC capacity, (2)
weak on both measures, (3) strong on insurance coverage and weak on CHC
capacity, and (4) weak on insurance coverage and strong on CHC capacity.

The authors found that

* The highest levels of access to care were found in communities with both
strong insurance coverage and strong CHC capacity.

* When comparing communities that had only a strong CHC capacity with
communities that had only strong insurance coverage, almost all access
measures were much better for people with low incomes in communities with
strong insurance coverage.

* Among communities with comparable levels of insurance coverage, access
to care was generally better in communities with a strong CHC capacity
than in those with a weak CHC capacity.

"Insurance coverage expansions should still be viewed as the main tool for
removing the financial barriers to the primary and specialty care services
that many uninsured people need but cannot afford," conclude the authors.
They add that "CHCs and other safety net providers will still play an
important role in filling . . . gaps."

"In the context of youth generally being more likely per capita than the
legal-age audience to see magazine advertising for beer and ale, distilled
spirits, and LARs [low-alcohol refreshers], perhaps the most striking
finding of our analysis is the level of overexposure experience by girls,"
state the authors of an article published in the July 2004 issue of the
Archives of Pediatrics and Adolescent Medicine. The article presents
findings from a study to measure boys' and girls' (ages 12-20) exposure to
magazine advertising for four different types of alcoholic beverages and
to compare this exposure to that of people ages 21 and older.

Researchers combined advertising occurrence (when and where an
advertisement was published) and magazine readership data drawn from
standard media-planning statistical sources to quantify levels of exposure
of different audiences to each alcoholic beverage brand's advertising.
They examined 255 alcoholic beverage brands advertised in 103 magazines in
2001 or 2002. For the purposes of this analysis, the brands were collapsed
into four categories: beer and ale, distilled spirits, LARs, and wine.
Dollars and advertisements were counted by alcoholic beverage brand and by
magazine. Gross rating points (reach x frequency), an advertising-industry
standard measure of audience exposure, were calculated to facilitate
comparison of the exposure of underage (ages 12-20) and legal-age (ages 21
and older) readers and of readers ages 12-20 and 21-34 (the latter is the
stated alcohol-industry target market).

The authors found that

* Between 2001 and 2002, underage exposure declined in every category
except LARs, for which boys' exposure increased by 46% and girls' by 216%.

* In 2002, on a per capita basis, compared with legal-age readers,
underage readers saw 45% more beer and ale advertising, 12% more distilled
spirits advertising, 65% more LAR advertising, and 69% less wine
advertising.

* Girls ages 12-20 had almost the same level of exposure to beer and ale
and LAR advertising as women ages 21-34, and girls were substantially more
likely to be exposed to beer and ale, LAR, and distilled spirits
advertising than were women 21 and older.

"These findings underscore the importance of the Institute of Medicine's
recent recommendation that alcohol companies limit their advertising to
vehicles for which youth are less than 25% of the total audience 12 years
and older and move toward a 15% threshold," state the authors.
(Adolescents ages 12-20 comprise 15.6% of the general U.S. population.)